Provider Demographics
NPI:1235183286
Name:TUCK, LORI R (LMHC)
Entity Type:Individual
Prefix:
First Name:LORI
Middle Name:R
Last Name:TUCK
Suffix:
Gender:F
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:506 EDSEBROOK DR
Mailing Address - Street 2:
Mailing Address - City:BOYLSTON
Mailing Address - State:MA
Mailing Address - Zip Code:01505
Mailing Address - Country:US
Mailing Address - Phone:508-869-6440
Mailing Address - Fax:
Practice Address - Street 1:157 UNION ST
Practice Address - Street 2:MARLBOROUGH HOSPITAL
Practice Address - City:MALBOROUGH
Practice Address - State:MA
Practice Address - Zip Code:01752
Practice Address - Country:US
Practice Address - Phone:508-486-5582
Practice Address - Fax:508-229-1206
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA4179101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor